Provider Demographics
NPI:1770039463
Name:RODRIGUEZ, MARIO GUILLERMO (RMDS)
Entity Type:Individual
Prefix:
First Name:MARIO
Middle Name:GUILLERMO
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:RMDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 W 10TH ST APT 4
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33010-4098
Mailing Address - Country:US
Mailing Address - Phone:786-443-8181
Mailing Address - Fax:
Practice Address - Street 1:17 W 10TH ST APT 4
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33010-4098
Practice Address - Country:US
Practice Address - Phone:786-443-8181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-31
Last Update Date:2016-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1403552471S1302X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonography